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After surgery

After Dupuytren's Treatment

Recovery after needle aponeurotomy or open palmar fasciectomy. The main differences are the extent of the wound and the length of therapy.

What was done

Your Dupuytren's contracture was treated in one of two ways:

  • Needle aponeurotomy (needling). Performed in the office or minor procedure room under local anesthesia. Several small needle punctures are made in the palm and fingers, weakening the tight Dupuytren's cords so that they can be snapped with a gentle stretch. Recovery is quick.
  • Open fasciectomy. Performed in the operating room, usually with regional or general anesthesia. The tight cord and diseased tissue in the palm and fingers are surgically removed through a longer incision. Recovery is more involved but the recurrence rate is lower.

The instructions below cover both; differences between the two are noted.

The first few days

  • Keep the dressing clean and dry. After needle aponeurotomy the dressing is usually small adhesive bandages that can come off at 24 to 48 hours; after an open fasciectomy a bulky dressing is in place for about 5 to 7 days.
  • Keep the hand elevated above the level of your heart as much as possible for the first 3 to 5 days.
  • Move the fingers often. Gentle active range of motion starts immediately — make a full fist and then fully straighten the fingers, many times a day.
  • Ice over the dressing (20 minutes on, 20 off) helps with swelling.
  • No lifting more than 5 pounds with the operated hand for the first 2 weeks.

Dressing changes and wound care

  • After needle aponeurotomy: the small puncture holes are covered with a bandage for 24 to 48 hours and then left open. They heal completely within a week. You can get the hand wet as soon as the bandages come off.
  • After open fasciectomy: keep the dressing on and dry for 5 to 7 days. At 5 to 7 days you can remove the dressing, shower and wash over the incision with soap and water, then pat dry and cover with a simple adhesive bandage. No soaking (baths, pools, hot tubs) for 2 weeks.

Splinting

  • A custom thermoplastic night splint is usually made by a hand therapist within the first week or two. The splint holds the fingers fully straight overnight and is one of the most important factors in preventing recurrence of the contracture.
  • Plan to wear the night splint for at least 3 months, often longer.
  • During the day the hand is used normally, without the splint, after the dressing comes off.

Hand therapy

  • A certified hand therapist is involved for most patients starting in the first 1 to 2 weeks. Therapy focuses on regaining full finger extension, scar mobilization, and edema control.
  • After needle aponeurotomy, many patients need only a few therapy sessions.
  • After open fasciectomy, therapy may continue for 6 to 12 weeks, with home exercises throughout.

Pain and expected symptoms

  • Most patients take over-the-counter pain medicine (acetaminophen and ibuprofen) for the first several days. Prescription pain medicine, if prescribed, is usually only needed for a few days after open surgery.
  • Bruising of the palm, often extending into the fingers, is common after either procedure and can look dramatic. It fades over 2 to 3 weeks.
  • Small skin tears ("popping" of tight skin) can occur during needle aponeurotomy when the cord breaks. These look scary at the time but heal quickly and rarely cause problems.
  • Scar tightness and a "pulling" sensation in the palm is normal for several weeks after open surgery and improves with scar massage and therapy.

Activity

  • Driving: after needle aponeurotomy, 1 to 2 days. After open fasciectomy, 3 to 7 days, once you can make a comfortable fist and are not on prescription pain medicine.
  • Typing / desk work: after needle aponeurotomy, same day. After open fasciectomy, within a few days as tolerated.
  • Return to light work: needle aponeurotomy, 1 to 3 days. Open fasciectomy, usually 1 to 2 weeks.
  • Return to heavy manual work: needle aponeurotomy, 1 to 2 weeks. Open fasciectomy, 6 to 8 weeks.

Follow-up

After needle aponeurotomy: follow-up at 1 to 2 weeks and then at 6 weeks. After open fasciectomy: wound check and suture removal at 10 to 14 days, and again at 6 weeks.

About recurrence

Dupuytren's disease is a biological condition; treatment corrects the contracture but does not cure the disease. Over years, new cords can form and the contracture can come back. Recurrence rates are higher after needle aponeurotomy than after open fasciectomy, but the trade-off is a much quicker recovery and the ability to repeat the procedure easily. Wearing a night splint and doing scar massage reduce recurrence rates.

Call the office right away if
  • You have a fever over 101°F
  • The incision or a skin tear is draining pus, is spreading red, or is very warm
  • Pain is worsening instead of improving after the first few days
  • You have new numbness or severe weakness in the fingers
  • A finger becomes pale, cold, or blue

Related

About Dupuytren's contracture · Home hand therapy

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